HIPAA Forms

The details for the HIPAA/Authorization for release of information forms are in a pdf format and can be downloaded printed or viewed with Adobe Acrobat Reader. To get Acrobat Reader for free,
click the yellow box below.

Below you will find
Health Insurance Portability & Accountability Act (HIPAA), Privacy Requirements and Medical Authorization forms from each carrier where available.

Aetna
Aetna HIPAA FAQ Form
Aetna HIPAA form
Aetna Privacy Rules

Anthem
Anthem HIPAA form

Atlantis
Atlantis Health History Coverage Form

Cigna
Cigna HIPAA form

GHI
GHI Authorization form

Guardian/Healthnet
HealthNet Disclosure form

HealthPass
HealthPass Business Associate Agreement

HIP

HIP Health Information form
HIP HIV Health Information form
HIP Phych Health Information form

Horizon
Horizon Authorization Disclosure form

LIA Health Alliance
LIA HIPAA form

MDNY
MDNY HIPAA form

Oxford
Oxford Member HIPAA Authorization form

Oxford Notice of Privacy Practices

United Healthcare
United Healthcare HIPAA form

Vytra
Vytra HIPAA Form

NY State Department of Insurance HIPAA Information

 

 

 
Long Island NY (516) 352-7000
New Jersey (973) 257-5558
Outside NY (800) 443-0343 - Las Vegas NV (800) 842-4742
copyright First National Administrators 2006